Being a GP trainee provides an exciting time. It’s when many learn how diverse the life of a GP can be, as it’s one of the few jobs that give the flexibility to do other things alongside your career.
We sat down with Nish Manek, GP registrar at Trumpington St Medical Practice, who shared with us what it was like to be a National Medical Director’s Clinical Fellow at NHS England, and how that led to her starting the ‘Next Generation GP’ programme.
What is the FMLM National Medical Director’s Clinical Fellowship?
The Fellowship scheme is sponsored by the National Medical Director (previously Sir Bruce Keogh) who appoints around 30 fellows a year. All the fellows are junior doctors from different specialities, at varying levels of training.
For a whole year, you are immersed in hands-on practical leadership experience at a senior level with one organisation, ranging from charities to the royal colleges. Many get assigned a project, while others find their own practical leadership experience.
I was lucky to work at NHS England with Dr Arvind Madan, NHS England’s Director of Primary Care. It was a brilliant year and an absolute privilege to be a part of the scheme. I would recommend it wholeheartedly.
What were your key takeaways from your time as a Fellow at NHS England?
Firstly, I learnt that issues that seem very black on white on the outside are often more complex than we might realise. It’s so easy to get frustrated and point fingers when you don’t see the full context of a problem or all the constraints people might be working within. Broadly, I found NHS England to be filled with good people with good intentions, working under challenging circumstances. As GPs we might get thanked 40 times a day, but I found that the people there were throwing everything into their jobs without that sense of immediate impact or instant gratification that we get as doctors. I developed a lot of respect for them over the year.
Secondly, it was a privilege to spend time with leaders like Sir Bruce and Arvind. The sense of imposter syndrome was overwhelming at first, and I never expected to be able to do more than hang around in the corner like a medical student on a ward round. The feeling I had isn’t unique, I know others at my level often felt like that too… but the leaders I worked with asked the Fellows to contribute in a way that was remarkable.
It also meant that I could also have very honest conversations with senior people, and I soon learnt that it wasn’t an easy journey for many of them – they often didn’t have a clear plan to get to where they have, they’ve failed along the way, and they sometimes feel the imposter syndrome too. But each one had a sense of purpose which kept them going.
Lastly, I learnt what leadership really means. I used to think it was about titles, seniority, and positions. But my experience taught me that leadership is really about two things: firstly, understanding yourself and your strengths really well, and secondly, having an idea of the kind of future you’d like to create. And then working out how and where you can combine those two to make a difference.
And you don’t have to be right at the top to do that. It’s often not about what you know and what you’ve done…but about people, trust and relationships.
How did your work stem into the Next Generation GP programme?
The first 6-7 weeks of my experience were so good. I felt so grateful for the exposure I was having, and I thought, “How can we get this out to more people?”. Not everyone wants to take a whole year out to do a Fellowship, so how can we get the takeaways to more GPs to make it more accessible? I felt like I had a responsibility to do something about it because general practice needs leaders more than ever.
I heard about a programme that a fantastic GP in Birmingham, Nick Harding, had set up for aspiring CCG leaders, and just knew I had to do something with the experience I’ve been given.
I asked Arvind to support my plan to run a 6-month evening programme for trainees and young GPs in London, completely free, with no other prerequisites. The first half of each evening is structured with a lecture or workshop about a topic that doesn’t get covered in traditional training (e.g the NHS structure, how to influence people) and the second part is an interview with a national leader (e.g. Sarah Wollaston, Helen Stokes Lampard) to tell their leadership story. It’s about really getting behind their title, discussing their mistakes and lessons learnt and understanding the advice they’d give to younger leaders.
The 6-month pilot was hugely successful, and the feedback exceeded even my own expectations. People told us they felt more hopeful about the future of general practice, empowered to make a difference, and had a new sense of belief that leadership can start at any level.
The team has grown to over 20 GP trainees and new GPs who are doing a fantastic job in helping me to lead it across the country. The programme is now in 8 cities with more than 420 participants, and it’s still growing.
What advice do you offer GP trainees?
To be honest, I spent a lot of time being fearful and not really knowing what leadership meant. The word ‘leadership’ can sound intimidating…but I now see that it doesn’t automatically equate to having a title, sitting in a tower and telling people what to do. Really and truthfully, it’s just about doing things.
I was lucky. I developed an idea, and people backed me. What drove me forward more than anything else was watching other leaders; I got my energy from seeing the depth of courage, humility and sense of purpose in them. And realising that they were normal people underneath it all! They had been at my stage once too, but they had chosen not to stand on the sidelines.
I realised that leadership isn’t about waiting until I get to that level and I could start doing it now. I knew I wasn’t going to spend the next 30 years waiting on the sidelines and being negative. I wanted to have a go at changing things.
What’s the next step in your career?
I’m in my final year of GP training now and still have a way to go! Thankfully my exams are done, but that’s just that start of learning to become a good GP, which I really care about.
I don’t have a grand plan as such, but I will continue to run the Next Generation GP programme alongside my training. I’m so passionate about what we’re doing and about investing in other people. And so, I want to find as many ways to do that as I can, and for as many people as we can continue to do it for. It feels like we have started something here that is taking on a momentum of its own and feeding an appetite for change that is so important to the future of general practice.
Another thing I’ve learnt is that the senior leaders that come to speak to us get energised by listening to the next generation. I think we also give them hope because they see we are full of energy and passion for wanting to make a difference.
So, what’s next? We’ll see… I think anyone could have done what I’ve done. I’ve been lucky that the right people backed me at the right time. But we have started a movement here that is deeply exciting – and there’s still more to be done.
You can find out more about the Next Generation GP programme here. http://bit.ly/NextGGP
Dr Nish Manek
GP trainee, Cambridge
National Medical Director’s Clinical Fellow at NHS England